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J Diarrhoeal Dis Res. 1992 Dec;10(4):193-200.

Trends in the management of childhood diarrhoea in Egypt: 1979-1990.

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Population Council, Dhaka, Bangladesh.


Until 1979, diarrhoeal disease accounted for roughly half of all infant and childhood deaths in Egypt, partly because curative care was largely inappropriate. The National Control of Diarrhoeal Diseases Project (NCDDP) addressed this problem from 1982 to 1991. Since 1979 many aspects of diarrhoeal disease in Egypt have been addressed in many studies. This paper reviews that literature, finding considerable improvements in case management, particularly in the use of oral rehydration solution and in feeding during diarrhoeal episodes. This is due primarily to the NCDDP. At the same time diarrhoeal mortality declined rapidly, both absolutely and as a percentage of total mortality. Persistent diarrhoeas, which have become an increasing proportion of the remaining mortality, have not been satisfactorily addressed, and irrational treatment with drugs remains a major problem.


In Egypt, roughly half of all the mortality among infants and children during the 1970s was from diarrhea. The Ministry of Health established a special program in 1982 to improve the case management of childhood diarrhea, the National Control of Diarrheal Diseases Project (NCDDP). Between 1983 and 1987, infant and childhood mortality rates from diarrhea were reduced by more than half, primarily through improved treatment. Diarrhea had customarily been treated by a combination of popular remedies and traditional and modern medicine, antidiarrheal drugs, or antibiotics. It was not widely appreciated that oral rehydration therapy (ORT) and nutritional support alone could eliminate the worst effects of diarrhea. In fact, the opposite was practiced. Breastfeeding was discontinued for days at a time, solid foods curtailed or stopped. In several surveys in the governorate of Menoufia during 1980-82, between 51% and 65% of lactating mothers stopped breastfeeding during the last diarrhea episode, and between 34% and 65% of mothers discontinued solid foods. The NCDDP program became national in 1984. By November 1985, 98% of Egyptian mothers had heard of ORT, 73% knew how to mix it properly, 64% had used it at some time in the past, 58% had used it in the child's last diarrheal episode, and 83% of those currently breastfeeding had continued during the most recent episode. There were moderately low ORT rates through 1983, rapid increases in 1984 and 1985, and stable rates since then. ORS was used for 1/3 to 1/5 of all diarrhea episodes during the late 1980s. Antidiarrheals and antiemetics are inappropriate, and antibiotics are to be used in dysentery and suspected cholera cases only, although they are still widely prescribed. In 1987 several studies were launched to investigate the epidemiology and management of persistent diarrhea.

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